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Stability and change in needs of patients with schizophrenic disorders : a 15and 17-year follow-up from first onset of psychosis, and a comparison between'objective'and'subjective'assessments of needs for care.

Need for care was studied in a Dutch incidence cohort of patients with schizophrenic disorders 15 and 17 years from first onset of psychosis.

Long-term course of the disorders varied from complete remission and full community participation to chronic psychosis and long-term hospital stay.

Fifty patients were assessed twice with the Needs For Care Assessment Schedule (NFCAS, Brewin and Wing 1989) ; at the latter follow-up an assessment was also made using the Camberwell Assessment of Need (CAN, Phelan et al. 1995).

The NFCAS is an investigator-or professional-based instrument which provides an'objective'assessment of needs.

Need for care was recorded in 22 areas of clinical and social functioning.

Comparison of the two assessments over a 2-year period demonstrated a high stability on the individual items (mean 88%, mostly concerning the absence of a problem twice), but did not show the expected stability of need status among this group of patients with chronic disorders.

One in five patients (22%) had no needs at all on both occasions and 56% of the patients showed a change in needs.

There was more negative than positive change : 28% suffered from new unmet needs at the 17-year follow-up, while only 12% had improved their status to no needs.

About one-third (36%) had at least one unmet need, mostly regarding psychotic symptoms, dyskinesia or underactivity.

The CAN provides a'subjective'assessment of needs according to the view of patients themselves. (...)